Pharmacological Cerebral Protection in Cardiac Surgery: An Update

Abstract

Aim of review: Postoperative cognitive dysfunction (POCD) remains a major issue in cardiovascular surgery, although advances have been made in anesthesia, surgery and neuroprotective measures. Pharmacological prevention and management of POCD has achieved some progress over the last one to two decades, yet no consensus or guideline being established.Method: The following key words in PubMed were searched: cerebral protection, brain protection, cardiac surgery, and postoperative cognitive decline, etc. Recent articles and literatures were searched and reviewed on the risk factors for POCD and the cerebral protective effects of pharmacological agents, in order to make a comprehensive review and offer an update.Recent findings: Risk factors for POCD reported in literatures include older age, male gender, cardiopulmonary bypass (CPB) use, cerebral embolization, pre-existing cognitive disturbance and genetic predisposition. The pharmacological agents with potential neuroprotective effects include volatile anesthetics, intravenous anesthetic agents, steroids, N-methyl-D-aspartate (NMDA) antagonists, nitric oxide carriers and some traditional Chinese herbal medicine such as gastrodin. Cerebral protection in current practice is achieved by a combination of different strategies including surgical (cerebral perfusion during CPB, aortic filter, carotid stents, avoidance of aortic atheroma) and nonsurgical measures (hypothermia, lumbar drain, management of mean arterial pressure, central venous pressure, cerebral perfusion pressure, pre- and post-conditioning, and cerebral regional oxygenation monitoring, etc).Summary: Multiple factors are associated with the incidence of POCD. Numerous pharmacological agents have been found to have certain degree of neuroprotective effects. Large-scale, randomized, multicenter clinical trials will be needed for the integration of these agents into our clinical practice. Citation: Henry Liu, Rayhan Tariq, Geoffrey Liu, Ling Yu. Pharmacological cerebral protection in cardiac surgery: an update. J Anesth Perioper Med 2017; 4: 23-37. doi: 10.24015/JAPM.2017.0004This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.